Cannabis-induced persisting perception disorder

Theatrical poster for the film Reefer Madness (USA, 1936)

In three subjects participating in Sofia Greene's internet survey, persistent visual disturbances (with a duration of 19, 7 and 4 years, respectively) have occurred after using marijuana for the first time, reminiscent of the slogan One moment of bliss... a lifetime of regret! in Reefer Madness (1936), the classic marijuana film and underground comedy favorite warning against the use of the devil's weed. A fourth subject developed progressive persisting perception disorder (with a duration of 9 years) shortly following the onset of heavy cannabis use. A fifth subject developed persisting perception disorder (with a duration of 3 years) after 4 years of heavy cannabis use. It is suggested that tetrahydrocannabinol, cannabidiol and cannabinol, the most abundant cannabinoids in marijuana, acted as the cause of the enduring visual snow in these cases.

Adelaide

Thus, a 33-year-old Hungarian female, living in the US, wrote: "The constant visual disturbances started when I was 14. After inhaling marijuana my field of vision instantly went black and my ears began to ring. My vision quickly returned but with it came the static. Since that day I have experienced visual static/snow and ringing noises 24 hours a day, 7 days a week for almost 20 years now. I consider marijuana to be the trigger for my vision problem. I don't take anything for it; nothing really seems to make it better or worse. All tests I had were o.k.: eyes - fine; ears – fine; MRI of brain – fine; CAT scan of brain, neck and region of the jugular bulb near the ear - all was fine. "

(A. [subject #12], Email to Sofia Greene, undated [2005])

Ludwig

Similarly, a 23-year-old male from Switzerland recorded: "I have never had symptoms of a migraine. It [i.e. the visual disturbance] started 7 years ago, after having smoked cannabis for the first time... I have since been suffering, for 7 years, from a 24 hour a day visual disturbance (no hallucinations). It's very difficult to explain; it's like dizziness. I can focus one point in my visual field and around it turns a little bit around and it doesn't focus the part around. It's a little bit like smoking cigarettes for the first time (nicotine flash)... I take Zyprexa [olanzapine] 1.5 mg per day, because doctors have diagnosed a psychosomatic illness; it seems to help a little bit. If I consume alcohol (while in a good mood), it seems that the visual disturbance is improved the following day (no joke). This could be related to anxiety; I consider anxiety to be related to the persisting visual problems. I have had several assessments: computer tomography; EKG; etc., everything was negative. I have also been to several doctors who said that it's unknown to have a 24 hour a day migraine. I feel helpless. I would like the disturbance to disappear. I have to fight against it all the time, and it obviously doesn't facilitate my studies at university. Hope to get an answer soon, and good luck for your project."

(L. [subject #16], Email to Sofia Greene, undated [2005]; additions in square brackets by Klaus Podoll)

Lisa [subject #489], Visual snow, 2007. © 2007 Lisa

Lisa

An 18-year-old German female wrote: "Visual snow (as well as panic attacks) began after single use of cannabis. Moreover [there is] a feeling of strangeness and unreality, I also see everything 'strange' and 'unreal'. At the beginning it was quite slight, over the 4 years it has become more."

(Lisa [subject #489], Augenrauschen - Augenrauschen - Wer hat alles Marihuana konsumiert?, December 4 and 5, 2007, and Email to Klaus Podoll, December 5, 2007; additions in square brackets by Klaus Podoll) [more]

James

Shortly following the onset of heavy cannabis use, a 23-year-old German male got a persisting perception disorder with a step-wise progression over the following 9 years up to now, featuring increased positive and negative afterimages (since 1998), flickering dots (since 2004) and impaired night vision as well as a sort of tunnel vision (since 2005). It is remarkable that the two last episodes had occurred despite strict cannabis abstinence since 2002.

(James [subject #481], Emails to Klaus Podoll, June 23, 2007, and November 25, 2007) [more]

Michael [subject #417], Sperm-like whizzing dots, 2007. © 2007 Michael (larger image see here)

Michael

Finally, following heavy cannabis use from the age of 16, a 20-year-old German male developed a persistent perception disorder that showed a slightly progressive course over the following 3 years up to now, despite discontinuing the use of cannabis a few months after the onset of his persistent visual symptoms that include visual snow, sperm-like whizzing dots, jittering lights, floaters, hypersensitivity to light and to visual discomfort, increased positive and negative afterimages, impaired night vision, increased halos and starbursts around lights. Ophthalmological and neurological examinations as well as EEG and cranial MRI yielded normal results.

(Michael [subject #417], Email to Klaus Podoll, August 16, 2007)

Advertisement for the film Reefer Madness (USA, 1936): "One MOMENT of BLISS - a LIFETIME of REGRET!"

The previously described cases are diagnosed, for the time being, as "Cannabis-Related Disorder Not Otherwise Specified" (DSM-IV 292.9, ICD-10 F12.19). As drug tests are not available, additional abuse of hallucinogens (admitted by Subject #37 who "once smoked pot laced with PCP" 13 years prior to the onset of visual snow and other symptoms) and thus the differential diagnosis of HPPD cannot be excluded for sure. The clinical existence of cannabis-induced persisting perception disorder is not established in current psychiatric classification systems or in medical literature (except for case reports by Levi and Miller, 1990, and Gaillard and Borruat, 2003), although it is debated by sufferers in internet forums such as the Ezboard forum Visual snow or static or the HPPD Forum. Prolonged depersonalization after cannabis use, however, has been reported by several authors in the psychiatric literature (Szymanski, 1981; Keshaven and Lishman, 1986; Moran, 1986; Peeters, 2005).

Henry David Abraham, MD. © 2006 Henry David Abraham

According to Dr. Henry David Abraham's clinical experience, a diagnosis of cannabis-induced persisting perception disorder may be considered in rare cases following a full diagnostic workup to exclude other disorders. "I have seen HPPD following only cannabis", he wrote in a personal communication; "But there is usually another disorder present, such as temporal lobe epilepsy. Persistent visual hallucinosis may also occur following many other neurological and psychiatric disorders, such as cortical tumor, intercurrent drug use or toxic exposures (heavy metals, insecticides, other aerosolized hydrocarbons, arsenic, bromism), migraine (as you know), systemic disorders with cerebral effects, such as SLE [Systemic Lupus Erythematosus], head trauma, intraocular pathology, and leisurely neurodegenerative disorders like MS [Multiple Sclerosis]. I consider HPPD a diagnosis which one makes after ruling out the others. That is why internet chat forums are so unreliable. Persons who have real symptoms make claims about them which are not always fully examined medically. But I have learned that as physicians we should never say never. That prepares us for the unexpected."

(Henry David Abraham, Email to Klaus Podoll, March 19, 2006; additions in square brackets by Klaus Podoll)

References

Gaillard MC, Borruat FX. Persisting visual hallucinations and illusions in previously drug-addicted patients. Klin Monatsbl Augenheilk 2003; 220: 176-178.
Keshaven MS, Lishman WA. Prolonged depersonalization following cannabis abuse. Br J Addict 1986; 81: 140-142.
Levi L, Miller NR. Visual illusions associated with previous drug abuse. J Clin Neuroophthalmol 1990; 10: 103-110.
Moran C. Depersonalization and agoraphobia associated with marijuana use. Br J Med Psychol 1986; 59: 187-196.
Peeters FP. [Chronic depersonalisation following cannabis use] [Article in Dutch] Ned Tijdschr Geneeskd 2005; 149: 1058-1061.
Szymanski HV. Prolonged depersonalization after marijuana use. Am J Psychiatry 1981; 138: 231-233.

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